Patients in whom ketorolac, aspirin, or any NSAID has caused hypersensitivity or allergic-type reactions; active peptic ulcer disease; recent GI bleeding or perforation; advanced renal impairment and in patients at risk for renal failure because of volume depletion; suspected or confirmed cerebrovascular bleeding; hemorrhagic diathesis, incomplete hemostasis, and patients at high risk of bleeding; history of peptic ulcer disease or GI bleeding; as prophylactic analgesia before any major surgery and intraoperatively when hemostasis is critical; for intrathecal or epidural administration; labor and delivery; lactation; concomitant use with aspirin or other NSAIDs; concomitant use with probenecid.

Limit therapy to 5 days. Oral therapy is indicated only as continuation therapy to IV/IM, and the combined use is not to exceed 5 days because of the increased risk of serious adverse reactions. The recommended total daily dose of ketorolac oral (max, 40 mg) is significantly lower than that for ketorolac IV/IM (max, 120 mg).

Contraindicated in patients with advanced renal impairment or at risk of renal failure caused by volume depletion.

Bleeding risk:

Bleeding risk is caused by platelet inhibition. Contraindicated in patients with suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, incomplete hemostasis, and those at high risk of bleeding. Contraindicated as preoperative analgesic or as intraoperative analgesic when hemostasis is critical and in patients at high risk of bleeding. Intrathecal/epidural administration is contraindicated because of alcohol content.

Hypersensitivity:

Contraindicated in patients who have previously demonstrated hypersensitivity to ketorolac or allergic manifestations to aspirin or other NSAIDs.

Labor, delivery, and breast-feeding:

Contraindicated in labor and delivery because it may adversely affect fetal circulation and inhibit uterine contractions. Contraindicated in breast-feeding.

Concomitant use with NSAIDs:

Contraindicated in patients currently receiving aspirin or NSAIDs.

Special populations:

Dosage should be adjusted for patients 65 y of age and older, for patients weighing less than 50 kg, and for patients with moderately elevated serum creatine.